Can a Single Scale Measure Different Body-Focused Repetitive Behaviors?

What you need to know

• Body-focused repetitive behaviors (BFRBs) like skin picking and hair pulling are common but often underdiagnosed and undertreated mental health issues.
• Researchers developed a new 8-item scale called the Generic BFRB Scale (GBS-8) to measure multiple types of BFRBs together.
• Testing showed the GBS-8 is reliable and valid for assessing BFRB severity across different behaviors.

What are body-focused repetitive behaviors?

Body-focused repetitive behaviors (BFRBs) are a group of related disorders where a person repeatedly performs behaviors focused on their body, often causing physical damage. Common examples include:

• Skin picking (excoriation disorder)
• Hair pulling (trichotillomania)
• Nail biting
• Lip or cheek biting

While many people engage in mild forms of these behaviors occasionally, BFRBs become problematic when they are difficult to control and interfere with daily life or cause significant distress.

BFRBs are more common than previously thought. Research suggests up to 5% of people may struggle with clinically significant BFRBs. However, these conditions often go undiagnosed and untreated, in part due to feelings of shame that prevent people from seeking help.

Why develop a new BFRB scale?

Previously, most research on BFRBs used separate scales to measure each specific behavior. For example, there were scales just for skin picking or just for hair pulling.

However, many people experience multiple types of BFRBs at the same time. The researchers note that in previous studies, over 50% of people with one BFRB reported having at least one other BFRB as well.

Additionally, different BFRBs share many similarities in terms of symptoms, causes, and treatments. Some researchers have proposed that BFRBs may be best understood as a group of related disorders rather than completely separate conditions.

For these reasons, the study authors wanted to create a single scale that could measure severity across different types of BFRBs. This would allow for easier comparison between different behaviors and potentially provide a more comprehensive picture of BFRB symptoms.

Developing the Generic BFRB Scale (GBS-8)

The researchers created the Generic BFRB Scale (GBS-8) based on an existing scale for skin picking. They adapted the questions to apply to multiple types of BFRBs.

The GBS-8 contains 8 items that ask about:

1. Frequency of urges to perform BFRBs
2. Intensity of urges
3. Time spent on BFRBs
4. Control over BFRBs
5. Emotional distress due to BFRBs
6. Interference with social/work life
7. Avoidance of situations due to BFRBs
8. Physical damage caused by BFRBs

Each item is rated on a 5-point scale from 0 (none/minimal) to 4 (extreme).

The researchers tested the GBS-8 in a study with 279 adults who reported having at least one BFRB. Participants completed the GBS-8 along with other questionnaires measuring BFRB symptoms, depression, and quality of life.

Key findings on the GBS-8

The study found several important results supporting the reliability and validity of the GBS-8:

• The scale showed good internal consistency, meaning the items reliably measured the same overall concept.

• Factor analysis revealed two main dimensions measured by the scale:

  1. Symptom severity (items 1-4)
  2. Impairment (items 5-8)

• Test-retest reliability was satisfactory, indicating the scale produces consistent results when given to the same person at different times.

• The GBS-8 correlated strongly with another measure of BFRBs, supporting its validity for measuring BFRB symptoms.

• It showed only moderate correlations with measures of depression and quality of life, suggesting it specifically measures BFRBs rather than general distress or wellbeing.

• The scale performed similarly well for people with few BFRBs and those with multiple BFRBs, indicating it can capture symptoms across different behaviors.

Potential benefits of the GBS-8

The researchers suggest several ways the GBS-8 could be useful:

1. Providing a single, global measure of BFRB severity across different behaviors. This allows for easier comparison between studies on different types of BFRBs.

2. Potentially revealing differences in how treatments work for various BFRBs. Using a consistent scale could show if a therapy is more effective for one behavior versus another.

3. Saving time compared to administering multiple separate scales for different BFRBs.

4. Supporting research on BFRBs as a unified group of related disorders rather than entirely separate conditions.

Limitations and future directions

The authors note some limitations of their study:

• The sample was mostly female and actively seeking help for BFRBs. More research is needed in other populations.

• As a self-report measure, the GBS-8 relies on people accurately reporting their own symptoms.

• While it provides an overall measure of BFRB severity, it doesn’t give detailed information on specific behaviors.

The researchers suggest future studies could:

• Use more advanced statistical techniques to further validate the scale’s structure
• Test the scale in paper-and-pencil format (this study used an online version)
• Develop scales that provide more detailed measurement of multiple specific BFRBs

Conclusions

• The Generic BFRB Scale (GBS-8) appears to be a reliable and valid measure of overall BFRB severity across different behaviors.
• It may be a useful tool for both research and clinical assessment of BFRBs.
• More research is needed to further validate the scale and explore its use in different populations.

The development of scales like the GBS-8 represents an important step in advancing our understanding and treatment of body-focused repetitive behaviors. By providing consistent ways to measure these often overlooked conditions, researchers and clinicians can work towards better supporting people struggling with BFRBs.